I'm a US primary care physician. Here's my take on it:
- why is it so hard for Americans to get exercise, which would promote both good health and sleep?
You are preaching to the choir. The only caveat is exercise late in the day can be a sleep disruptor. Exercise has also been shown to work as well as some anti-depressants in terms of depression rating improvement (PHQ-9).
- for what reason do we use "sleeping pills" (sounds orwellian af tbh) and why is it so widespread? it's not only because pharmaceutical companies are creating artificial demand (although this likely plays a role).
One reason is patient demand. They want a quick fix, not something that takes work. Doctors play into this because of conveyor belt medicine where 20-25 patient visits are crammed into a day. Pills are faster than stepping someone through sleep training or talking about exercise. I get painted in what I call the 'pharmacological corner' sometimes where every suggestion other than sleeping pills is shot down by the patient.
I still rarely prescribe or if I do it's for intermittent use.
- do the citizens of other countries "require" as many sleeping pills as do we Americans? if so, are there any traits they share in common with us?
Interesting question -- I have no clue. I volunteered at a Coronary Care unit in Thailand and found that both opiate use and sleeping pills were much less officially prescribed but you could get both on your own under the counter at some pharmacies.
- what are the contraindications of combining "sleeping pills" with the many other medications to which americans are daily exposed, both voluntarily and involuntarily?
Benzodiazepines potentiate the euphoric effect of opiates which is why many pain clinics and physicians won't prescribe them together. Both sleeping pills and opiates are CNS depressants and their additive effect and worsen the chances for respiratory compromise.